Ankle Impingement — What You Should Know

Ankle impingement, also known as “footballer’s ankle” or “dancer’s heel,” occurs when spurs form on the bones of the ankle—specifically the tibia, fibula, and talus.

These bone spurs can form either on the front of the ankle joint (anterior ankle impingement syndrome) or the back (posterior impingement syndrome), and they strike or pinch the soft tissue in the ankle—the ligaments and tendons—causing pain, swelling, and inflammation.

Anterior vs. Posterior Ankle Impingement Syndrome

Anterior ankle impingement syndrome is commonly known as “footballer’s ankle,” and it usually occurs when the talus and the tibia, the two bones that comprise the front part of the ankle, are frequently forced against each other in a way that causes bone spurs to form.

This results from constant, repeated dorsiflexion (bending the foot upward, toward the shin, as one might do when kicking a soccer ball) over a long period of time. Symptoms of anterior ankle impingement syndrome include:

Tenderness on the front part of the ankle

Pain with movement of the ankle, especially dorsiflexion (upward movement of the foot); this pain is much worse

Pain when kicking a ball

Pain when walking uphill

A bony lump where the talus meets the tibia (leg bone), which may in some cases be detectable by touch

Although athletic activity is the most common cause of anterior ankle impingement, it can also be caused by ankle arthritis. Ankle injuries, especially sprains, can also cause or contribute to this condition if scar tissue builds up in the space between the tibia and talus, or if the tendons thicken as a result of repeated injury.

This scar tissue can become painfully caught between the two bones.

Posterior ankle impingement syndrome, also called os trigonum syndrome, is commonly known as “dancer’s heel.” This results from the compression of the soft tissues at the rear of the ankle, which causes spurs to form.

It is common not only in dancers, but in all athletes whose practice or gameplay involves frequent plantarflexion—flexing the foot downward. The chief symptom of posterior ankle impingement syndrome is pain and tenderness in the back part of the ankle, near the tip of the fibula.

This pain is caused by soft tissue becoming trapped between the ankle and heel bone (calcaneus), and it becomes worse when the foot is pointed downward, which pinches and squeezes the soft tissue between these bones in a manner some doctors describe as like a nut in a nutcracker.

The affected person’s range of motion is, of course, severely limited by this condition.

Risk Factors of Ankle Impingement

The primary risk factor for ankle impingement is athletic activity that puts specific kinds of stress on the ankle. Soccer players are at particular risk for anterior ankle impingement syndrome (hence the name “footballer’s ankle”), and ballet dancers are at great risk for posterior ankle impingement (hence the name “dancer’s heel”).

Basketball players are also at risk for posterior ankle impingement due to the constant jumping required in the game.

What Are The Complications of Ankle Impingement?

Ankle impingement can prevent dancers and athletes from functioning, and if not treated it can eventually cause antalgic gait (or limping, in layman’s terms).

How is Ankle Impingement Diagnosed?

How is Ankle Impingement Treated?

For posterior ankle impingement, rest and immobilization may sometimes be effective conservative treatments. Steroid injection directly into the ankle may also help. If conservative treatment fails, however, surgery will be required to remove the bone spur.

Surgical treatment may involve ankle cheilectomy, an operation to remove bone spurs from either the talus or the tibia (this may not help if you have arthritis, however).

If the condition is caused by scar tissue from old injuries, arthroscopic ankle surgery can be performed to remove this scar tissue.

Arthroscopy involves the use of a tiny camera and instruments attached to a long, flexible tube inserted through a small incision; because it is less invasive, it can mean a shorter recovery time for the patient.

Can Ankle Impingement Be Prevented?

It is important for athletes to keep limber. For dancers, it is especially important to routinely stretch the soft tissues located at the back of the heel, including the Achilles tendon, in order to minimize the stress these tissues are subjected to.

What is The Prognosis for Ankle Impingement?

The removal of bone spurs usually increases the patient’s range of motion, although in some cases there may be less improvement than hoped for if the ligaments and tendons remain tight.

In most cases, with appropriate treatment, normal gait and range of motion can be restored, although ankle impingement may affect an athlete’s career in the long run.

Medical References:

Podiatry Today
http://www.podiatrytoday.com/article/7485
London Foot & Ankle Surgery
http://www.londonfootandanklesurgery.co.uk/footballer-ankle.html
The National Institutes of Health
http://www.nlm.nih.gov/medlineplus/ency/article/007584.htm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535150/
American Orthopaedic Foot & Ankle Society
http://www.aofas.org/footcaremd/treatments/Pages/Ankle-Arthroscopy.aspx
http://www.aofas.org/footcaremd/treatments/Pages/Ankle-Cheilectomy.aspx
Journal of the American Academy of Orthopaedic Surgeons
http://www.jaaos.org/content/22/5/333.full.pdf
The Journal of Bone and Joint Surgery
http://www.boneandjoint.org.uk/highwire/filestream/40690/field_highwire_article_pdf/0/550.full-text.pdf
American Academy of Pediatrics
http://www.healthychildren.org/English/healthy-living/sports/Pages/Ballet-and-Dance.aspx
The University of California, San Francisco
http://www.ucsfhealth.org/conditions/dancers_heel/

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